Mental Health Literacy in an Asian Immigrant Group: Does Social Network Size Matter?

Background: Mental health problems, such as depression and anxiety, are serious problems among Korean American (KA) women, but many KA women do not seek mental health treatment. A lower level of mental health literacy has been found to account for low rates of mental health services, contributing to mental health disparity for this population compared to other racial/ethnic groups. This study utilized Andersen’s Behavioral Model to bridge gaps of knowledge by investigating: (1) current levels of mental health literacy among KA women and (2) factors associated with mental health literacy among KA women.

Methods: A cross-sectional survey research design was used for this study. The sample was 243 KA women, aged 21 to 85 in a large Southeastern city in the U. S. A quota sampling was used to ensure approximately the same number of women in each of the following age categories: 21 to 29, 30 to 39, 40 to 49, 50 to 59, 60-69, and 70-85. This study utilized two data collection methods: (1) face-to-face interviews with the women aged ≥ 60, and (2) self-administered questionnaires with those aged ≤ 60. Dependent variable was mental health literacy. Independent variables were predisposing factors (age, marital status, education); enabling factors (English proficiency, social network, having a primary physician), and need factor (depression). Data analyses included descriptive analyses, bivariate analysis, and multiple linear regression for mental health literacy. 

Results: Study findings showed that while participants recognized their own mental health problems at a relatively high level, their knowledge of mental health resources and services available in the community, how to access them, and mental health-related terms were low. The model fit well with the data (R²=.221, F=9.134, p<.001) and accounted for 22% of variance. Results showed that KA women who have better English speaking skill were likely to have higher mental health literacy (β=.339, SE=.085, p<.001); KA women who have bigger social network size were likely to have higher mental health literacy (β=.132, SE=.070, p<.05); and KA women who have higher depression level were likely to have lower mental health literacy (β=-.150, SE=.115, p<.05).

Conclusions: This study has several practice implications for interventions to increase mental health literacy among KA women. First, mental health-related materials and education should be developed and delivered in Korean to target KA women with limited English proficiency. Distributing the materials and conducting educational programs in places where KAs congregate, such as Korean churches and primary care physicians’ offices, could be an effective strategy. Second, informed by the finding that depression was negatively related to mental health literacy among KA women, it would be critical to work with healthcare providers to provide education to their patients using materials written in Korean, especially those who work with KA women with depression. Finally, considering the significant relationship between the size of social network and mental health literacy among KA women, strategies to encourage sharing of mental health-related information with families and friends by increasing the social network size may be effective in increasing mental health literacy among this population.